The Mental Health of Women with Fertility Difficulties on their Path to Motherhood: The Contribution of Internal Resources, Cognitive Appraisal and Mother-Daughter Relationship

The current series of studies investigated a variety of personal resources of women with fertility problems on their path to motherhood, and the point of view of both these women and their mothers. The two quantitative studies were part of the POWER (Positive Outlook on Women Entering Reproductive treatment), a large-scale research project. Study 1, a cross-sectional quantitative study, examined perceived stress of women after initial consultation with fertility specialist. Study 2, a prospective quantitative study, examined mental health of pregnant women with the background of fertility problems. Study 3 was a qualitative study exploring the experience of mothers whose daughters encountered fertility problems and underwent treatment to bring their first child into the world.

More specifically, Study 1 sought to examine the contribution of the internal resources of meaning in life and attachment style and the interpersonal resource of self-disclosure to her mother to a woman's level of perceived stress after initial consultation with a fertility specialist. In addition, we examined the association between age and perceived stress. The sample consisted of 180 Israeli women (106 aged 20-34; 74 aged 35-44) who completed a series of self-report questionnaires after their initial meeting with a fertility specialist. Regression analysis indicated that older age, lower attachment anxiety, higher perception of meaning in life, and greater self-disclosure to the mother were related to lower levels of perceived stress. Self-disclosure was also found to mediate the association between avoidant attachment and stress. The study highlighted the importance of a woman’s personal and interpersonal resources for reducing the experience of stress before embarking on fertility treatment. The results have practical implications for the development of professional interventions seeking to enhance these resources among women embarking on fertility treatment.

Study 2 examined the mental health of pregnant women who had had difficulty conceiving, investigating the contribution of meaning in life (both presence and search for meaning) on their first visit to a fertility clinic, as well as the change in meaning in life during the pregnancy and the cognitive appraisal of the pregnancy (threat, challenge, self-efficacy). A sample of 136 pregnant women completed a set of self-report questionnaires after the initial consultation with a fertility specialist (Phase 1) and again during gestation week 12-33 (Phase 2). Participants belonged to three groups according to the manner of conception (spontaneous, IVF, other fertility treatments). No differences were found between the groups on the study variables. For the whole sample, significantly higher presence of meaning in life was reported during pregnancy than following the first consultation with a fertility specialist. Presence of meaning at Phase 1, change in presence of meaning between the two phases, and cognitive appraisal of self-efficacy contributed to women’s better mental health during pregnancy. Self-efficacy also mediated the relationship between the change in presence of meaning and mental health, and moderated the link between group and mental health.

Study 3 explored qualitatively the experience of mothers whose daughters encountered fertility problems and underwent fertility treatment with their first child. Face-to-face semi-structured interviews were conducted with 16 women aged 49 to 73. Women were included in the study if they had a daughter in a spousal heterosexual relationship who conceived her first child via fertility treatment, and this child was up to four years old at the time of the interview. Three main themes emerged: (1) The stressfulness of a daughter’s fertility problems and treatments for the mother; (2) The mother’s supportive role; and (3) The mother's own need for support. The results indicate that due to the unique nature of the mother-daughter relationship, a daughter’s fertility problems and treatments are also stressful for her mother. Nevertheless, mothers can be, and wish to be, an important source of support for their daughters.

This series of studies contributes to the literature by virtue of the variety of factors examined, the various methods that were applied (both cross-sectional and longitudinal designs, quantitative and qualitative studies) and the novelty of examining the mother-daughter dyad in the context of fertility problems.

The results have practical implications for the development of professional interventions seeking to enhance meaning in life among women embarking on fertility treatment and afterwards during the pregnancy, as well as their belief in their competence to cope with the challenges of pregnancy. Moreover, interventions aimed specifically at women embarking on fertility treatments should relate differentially to younger and older women and should also take into account their attachment style. In addition, professionals should be aware of the complexity of the mother-daughter dyad, that may serve as a resource for women, considering also the mother’s distress and the fact that she is likely to deny her own need for support when her daughter experiences fertility problems trying to conceive.